From the Research
Treatment for Blastocystis in a patient with persistent diarrhea and abdominal discomfort is generally not recommended, as the latest and highest quality study suggests that there is no advantage for antibiotic treatment over placebo in Blastocystis hominis-positive patients with recurrent abdominal pain. The study published in the Journal of Pediatric Gastroenterology and Nutrition in 2012 1 found that trimethoprim-sulfamethoxazole (TMP/SMX) did not provide any significant benefit over placebo in reducing pain index in children with recurrent abdominal pain and Blastocystis hominis infection.
Considering the potential for antibiotic resistance and side effects, it is essential to weigh the risks and benefits of treatment. The pathogenic role of Blastocystis remains controversial, and treatment should be reserved for symptomatic patients with no other identified cause for their symptoms.
Some key points to consider:
- The latest study suggests that antibiotic treatment may not be effective in eradicating Blastocystis or improving symptoms 1.
- Other studies have reported variable rates of clinical cure and eradication of the parasite with different treatments, including metronidazole and trimethoprim-sulfamethoxazole 2, 3.
- Dietary modifications, such as reducing fermentable carbohydrates (low FODMAP diet), may help manage symptoms during and after treatment.
- Follow-up stool testing after treatment completion can confirm eradication, though clinical improvement is the primary goal rather than complete elimination of the organism.
In this case, given the lack of strong evidence supporting the effectiveness of antibiotic treatment for Blastocystis, a conservative approach with close monitoring of symptoms and consideration of alternative treatments, such as dietary modifications, may be the best course of action.